ADHD (Attention-Deficit/Hyperactivity Disorder)

ADHD stands for attention-deficit/hyperactivity disorder. It refers to a disorder of self-regulation that begins in childhood and persists over the years. In the International Classification of Diseases, ICD-10, it is listed under F90 as part of the hyperkinetic disorders.

In the past, a child who acted out was often called a “fidgety kid.” Today we know that this behavior stems from a change in brain function, not from a lack of good will. Children with ADHD have more difficulty concentrating, rarely sit still, and often act before they think. This behavior is more pronounced and persistent than is typical for their age, and it manifests in various areas of life: at home, at school, and when playing with others.

A restless child does not automatically have ADHD. Every child is sometimes restless, unfocused, or cheeky. Only when these behaviors significantly interfere with daily life, persist for at least six months, and began before the age of twelve is a diagnosis even considered. Furthermore, ADHD does not always go away with age: in about half of those affected, some symptoms remain noticeable well into adulthood.

Experts describe ADHD in terms of three areas, which can vary in severity.

• Inattention: The child is easily distracted, fails to hear instructions, loses things, forgets tasks, and fails to finish what they start. Some children appear calm and dreamy and go largely unnoticed for a long time.
• Hyperactivity: A constant urge to move. The child fidgets with their hands and feet, stands up in class, talks a lot, and has a hard time settling down. For more on this, see “Hyperactivity.”
• Impulsivity: The child blurts out answers, has trouble waiting, interrupts others, and acts without considering the consequences.

An example from everyday life: While doing homework, the boy gets up every few minutes; his pencil suddenly goes missing; his mother’s questions go unheeded; and after ten minutes, half of the homework remains undone. Such scenes repeat themselves day after day and take a toll on everyone involved.

Not every child exhibits all three areas with equal clarity. For some, restlessness is the main issue; for others, it’s almost exclusively inattention. Girls are more often of the quieter, inattentive type and therefore go undetected for longer.

ADHD is one of the most common mental disorders in childhood and adolescence. About five percent of 6- to 18-year-olds are affected—roughly half a million children and adolescents in Germany. Boys are diagnosed three to six times as often as girls.

The causes lie in the biology of the brain. In ADHD, the neurotransmitters dopamine and norepinephrine—which transmit signals between nerve cells—do not function in their usual balance. As a result, the brain regions responsible for concentration, motivation, and impulse control regulate behavior less reliably. The predisposition is strongly hereditary: professional associations estimate that genetics account for about 80 percent of the condition, and in many families, parents or siblings are also affected.

Parenting, media consumption, or sugar do not cause ADHD. Unfavorable conditions at home or school can exacerbate or mitigate the condition, but they are not the root cause. This relieves parents of the burden of wondering what they did wrong.

A reliable diagnosis takes time and involves several steps. A child and adolescent psychiatrist or a pediatrician specializing in this area will talk at length with the parents and the child, have questionnaires filled out at home and at school, and observe the child. It is important that the symptoms occur in various situations and not just in a single setting.

There is no single test that definitively proves ADHD. The diagnosis is based on the overall picture. In addition, the team will investigate whether there is another underlying cause, such as lack of sleep, vision or hearing problems, anxiety, or family stress. Often, other issues are present as well, such as learning difficulties, tics, or a depressive mood. Identifying these co-occurring conditions is also part of the evaluation.

The wait for an appointment in child and adolescent psychiatry is often several months. This time can be stressful for parents. It helps to get on the waiting list early and, in the meantime, keep notes about daily life that will be useful during the evaluation.

ADHD responds well to treatment, even though it usually does not disappear completely. A multimodal approach that combines several components and is tailored to the child’s age is considered effective.

• Education (psychoeducation): Parents and children learn what ADHD is and what strategies can make daily life easier.
• Parental support: Through parent training, parents learn to establish clear structures, set reliable rules, and offer targeted praise.
• Behavioral therapy: The child practices controlling their attention and curbing impulsivity; the school is involved.
• Medication: In cases of severe ADHD, medications such as methylphenidate can help, usually starting in elementary school and used in conjunction with the other components. Parents’ attitudes toward this step vary widely; see “Deciding on Medication” for more information.

Which components are appropriate depends on the severity of the condition, the child’s age, and any accompanying issues. In mild cases, counseling and behavioral strategies are often sufficient. In daily life, structured routines, manageable tasks, physical activity, and adequate sleep provide support. Many children with ADHD also have strengths, such as enthusiasm, creativity, and perseverance when it comes to things that captivate them. Treatment focuses precisely on these areas and builds on what is already working.

The first point of contact is your child’s pediatrician. From there, you’ll be referred to a child and adolescent psychiatry clinic or a practice specializing in ADHD. It’s a good idea to schedule an appointment if your child has been clearly struggling or causing friction at school, at home, or with friends for months, and if daily life has become very stressful.

Until the appointment, it helps to write down specific observations: when, where, and how often certain situations occur. Parenting coaching, such as Rückenwind, can support you during this time, help you gain perspective, and provide you with strength between appointments. The diagnosis of ADHD and the decision regarding treatment rest solely with a child and adolescent psychiatrist or a medical or psychotherapeutic specialist.